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General NPI Number Information
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NPI Number | 1225060031
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Entity Type | Individual
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Provider Name | ROBERT F. CROCHELT M.D., PHD., F.A.C.S.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 246 HOSPITAL DR
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City | UKIAH
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State | CA
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Zip | 95482-4533
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Country | US
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Telephone | 707-462-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 246 HOSPITAL DR
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City | UKIAH
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State | CA
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Zip | 95482-4533
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Country | US
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Telephone | 707-463-8011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35923
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G069042
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License Number State | CA
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